CHAPTER 18. STATE BOARD OF MEDICINE PRACTITIONERS OTHER THAN MEDICAL DOCTORS

Ch. 18 OTHER PRACTITIONERS 49 CHAPTER 18. STATE BOARD OF MEDICINE PRACTITIONERS OTHER THAN MEDICAL DOCTORS Subchap. Sec. A. LICENSURE AND REGULATION OF MIDWIFE ACTIVITIES... 18.1 B. REGISTRATION AND PRACTICE OF ACUPUNCTURISTS AND PRACTITIONERS OF ORIENTAL MEDICINE... 18.11 C. [Reserved]... 18.21 D. PHYSICIAN ASSISTANTS... 18.121 E. PERFORMANCE OF RADIOLOGIC PROCEDURES BY AUXILIARY PERSONNEL... 18.201 F. RESPIRATORY THERAPISTS... 18.301 G. MEDICAL DOCTOR DELEGATION OF MEDICAL SERVICES.. 18.401 H. ATHLETIC TRAINERS... 18.501 I. BEHAVIOR SPECIALISTS... 18.521 J. PERFUSIONISTS...18.601 K. GENETIC COUNSELORS...18.701 L. PROSTHETISTS, ORTHOTISTS, PEDORTHISTS AND ORTHOTIC FITTERS...18.801 The provisions of this Chapter 18 issued under sections 6(a) and (d), 8 and 51 of the Medical Practice Act of 1985 (63 P. S. 422.6(a) and (d), 422.8 and 422.1 note); section 812.1 of The Administrative Code of 1929 (71 P. S. 279.3a); and section 3(b) of the Acupuncture Registration Act (63 P. S. 1803(b)), unless otherwise noted. The provisions of this Chapter 18 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24, unless otherwise noted. This chapter cited in 6 Pa. Code 22.62 (relating to conditions of provider participation); 6 Pa. Code 22.82 (relating to false or fraudulent claims by providers); 25 Pa. Code 215.24 (relating to human use); 28 Pa. Code 107.12a (relating to specified professional personnel statement of policy); 28 Pa. Code 501.4 (relating to regulations); 28 Pa. Code 601.3 (relating to requirements for home health care agencies); 49 Pa. Code 16.1 (relating to definitions); 49 Pa. Code 16.2 (relating to rules governing Board activities and proceedings); 49 Pa. Code 16.12 (relating to general qualifications for licenses and certificates); 49 Pa. Code 16.55 (relating to complaint process); 49 Pa. Code 16.61 (relating to unprofessional and immoral conduct); 49 Pa. Code 16.62 (relating to complaint process); 49 Pa. Code 17.8 (relating to licenses, certificates and registrations issued prior to January 1, 1986); and 49 Pa. Code 25.504 (relating to certification of respiratory care practitioners; practice; exceptions). Subchapter A. LICENSURE AND REGULATION OF MIDWIFE ACTIVITIES Sec. 18.1. Definitions. 18.2. Licensure requirements. 18.3. Biennial registration requirements. 18.4. Midwife protocol. 18.5. Collaborative agreements. 18.6. Practice of midwifery. 18.6a. Prescribing, dispensing and administering drugs. 18.7. Disciplinary and corrective measures. 18.8. [Reserved]. 18.9. Notification of changes in collaboration. (387687) No. 515 Oct. 17 18-1

49 18.1 DEPARTMENT OF STATE Pt. I This subchapter cited in 49 Pa. Code 107.12a (relating to specified professional personnel statement of policy). 18.1. Definitions. The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise: ACME The American Commission for Midwifery Education. ACNM The American College of Nurse-Midwives. AMCB The American Midwifery Certification Board. Collaborating physician A medical or osteopathic doctor who has entered into a collaborative agreement with a nurse-midwife. Collaborative agreement A signed written agreement between a midwife and collaborating physician in which they agree to the details of the collaborative arrangement between them with respect to care of midwifery clients. Legend drug A drug: (i) Limited by the Federal Food, Drug and Cosmetic Act (21 U.S.C.A. 301 399) to being dispensed by prescription. (ii) The product label of which is required to contain the following statement: Rx only. Midwife examination An examination offered or recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of midwifery to qualify for a nurse-midwife license. The Board recognizes as midwife examinations the certifying examinations of the ACNM, the ACNM Certification Council, Inc. (ACC), and AMCB, or their successor organizations. Midwifery practice Management of the care of essentially normal women and their normal neonates. This includes antepartum, intrapartum, postpartum and nonsurgically related gynecological care. Midwife program An academic and clinical program of study in midwifery which has been approved by the Board or by an accrediting body recognized by the Board. The Board recognizes the ACNM and ACME or their successor organization as an accrediting body of programs of study in midwifery. Midwife practice guidelines A written document developed by the nursemidwife setting forth, in detail, the scope and limitations of the nursemidwife s intended practice. Neonate An infant during the first 28 days following birth. Nurse-midwife A person licensed by the Board to practice midwifery. The provisions of this 18.1 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). 18-2 (387688) No. 515 Oct. 17 Copyright 2017 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.2 The provisions of this 18.1 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial page (328702). This section cited in 49 Pa. Code 18.6 (relating to practice of midwifery). 18.2. Licensure requirements. The Board will grant a nurse-midwife license to an applicant who meets the following requirements. The applicant shall: (1) Be licensed as a registered nurse in this Commonwealth. (2) Satisfy the licensure requirements in 16.12 (relating to general qualifications for licenses and certificates). (3) Have successfully completed a midwife progam. (4) Have obtained one of the following: (i) A passing grade on a midwife examination. The Board accepts the passing grade on the certifying examination of the ACNM or AMCB as determined by the ACNM or AMCB or successor organization as recognized by the Board. (ii) Certification as a midwife by the American College of Nurse- Midwives (ACNM) before the ACNM certification examination was first administered in 1971. To be eligible for renewal of a nurse-midwife license, the nurse-midwife shall maintain National certification available to the profession and recognized by the Board. (5) Submit an application for a nurse-midwife license accompanied by the required fee. For the fee amount, see 16.13 (relating to licensure, certification, examination and registration fees). The provisions of this 18.2 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). The provisions of this 18.2 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial pages (299567) and (222901). 18.3. Biennial registration requirements. (a) A nurse-midwife license shall be registered biennially. The procedure for the biennial registration of a nurse-midwife license is in 16.15 (relating to biennial registration; inactive status and unregistered status). (342659) No. 415 Jun. 09 18-3

49 18.4 DEPARTMENT OF STATE Pt. I (b) As a condition of biennial license renewal, a nurse-midwife shall complete the continuing education requirement in section 12.1 of the Professional Nursing Law (63 P. S. 222). In the case of a nurse-midwife who has prescriptive authority under the act, the continuing education required by the Professional Nursing Law (630.5 211 225.5) must include at least 16 hours in pharmacology completed each biennium. (c) The fees for the biennial renewal of a nurse-midwife license and prescriptive authority are set forth in 16.13 (relating to licensure, certification, examination and registration fees). The provisions of this 18.3 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). The provisions of this 18.3 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial page (222901). 18.4. Midwife practice guidelines. At a minimum, the midwife practice guidelines must identify the following: (1) The procedures and routines of care, including specific treatment regimens to be provided by the midwife, by practice area for example, antepartum, intrapartum, postpartum and nonsurgically related gynecological care. (2) The circumstances under which consultation, co-management, referral and transfer of care of women and neonates are to take place, and the mechanics by which each are to occur. (3) Procedures and routines of care of neonates, including specific treatment regimens, if the nurse-midwife manages the care of neonates beyond the time of delivery. The provisions of this 18.4 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). The provisions of this 18.4 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial pages (222901) to (222902). 18-4 (342660) No. 415 Jun. 09 Copyright 2009 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.5 18.5. Collaborative agreements. (a) A nurse-midwife may not engage in midwifery practice without having entered into a collaborative agreement and having filed the collaborative agreement with the Board. (b) A nurse-midwife shall only engage in midwifery practice in accordance with the midwife practice guidelines and collaborative agreements. (c) A collaborative agreement must contain either an acknowledgement that the nurse-midwife shall practice under the midwife practice guidelines, or that the nurse-midwife shall practice under the midwife practice guidelines as expanded or modified in the collaborative agreement. (d) Expansions and modifications of the midwife practice guidelines agreed to by the nurse-midwife and the collaborating physician shall be set forth, in detail, in the collaborative agreement. (e) If the collaborating physician intends to authorize the nurse-midwife to relay to other health care providers medical regimens prescribed by that physician, including drug regimens, that authority, as well as the prescribed regimens, shall be set forth in the collaborative agreement. (f) The physician with whom a nurse-midwife has a collaborative agreement shall have hospital privileges or a formal arrangement for patient admission to a hospital and shall practice in the specialty area of the care for which the physician is providing collaborative services. (g) Collaborative agreements must meet the following requirements: (1) The agreement must provide a predetermined plan for emergency services, and immediate availability of a physician to the nurse-midwife by direct communication or by radio, telephone or other telecommunication for consultation, co-management, or transfer of care as indicated by the health status of the patient. (2) The agreement must identify and be signed by at least one collaborating physician and the nurse-midwife. (3) A physician providing coverage need not be signatory to the collaborative agreement, but shall agree to adhere to the terms of the collaborative agreement, and shall be identified by name of physician, or name of group, or name of service. (4) A physician providing interim coverage need not be signatory to the collaborative agreement, but shall agree to adhere to the terms of the collaborative agreement. (5) Both the collaborating physician and the nurse-midwife are responsible to assure adherence to the terms and conditions of the collaborative agreement by themselves, others as appropriate within their practice groups, and physicians providing coverage. (h) The collaborative agreement must satisfy the substantive requirements set forth in subsections (a) (e) and be consistent with relevant provisions of the act (342661) No. 415 Jun. 09 18-5

49 18.6 DEPARTMENT OF STATE Pt. I and this subchapter, and must be filed with the Board. For a nurse-midwife with prescriptive authority, the collaborative agreement with a physician must identify the categories of drugs from which the nurse-midwife may prescribe or dispense and any restrictions thereto. (i) A nurse-midwife or collaborating physician shall provide immediate access to the collaborative agreement to any client, pharmacist, licensed health care facility, licensed health care provider, physician, or the Board seeking to confirm the scope of the nurse-midwife s authority, and the nurse-midwife s ability to prescribe or dispense a drug. The provisions of this 18.5 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). The provisions of this 18.5 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial page (222902). 18.6. Practice of midwifery. The nurse-midwife is authorized or required, or both, to do the following: (1) Engage in midwifery practice as defined in 18.1 (relating to definitions), as further provided for in this subchapter and in accordance with the ethical and quality standards of the profession as required in section 41(8) of the act (63 P. S. 422.41(8)). (2) Maintain a midwife protocol and collaborative agreements, and make them available for inspection by clients and the Board upon request. (3) Prescribe medical, therapeutic and diagnostic measures for essentially normal women and their normal neonates in accordance with the midwife protocol or a collaborative agreement, or both. (4) Administer specified drugs as provided in collaborative agreements or as directed by a collaborating physician for a specific patient and, if specifically authorized to do so in a collaborative agreement, relay to other health care providers medical regimens prescribed by the collaborating physician, including drug regimens. (5) A nurse-midwife may, in accordance with a collaborative agreement with a physician, and consistent with the nurse-midwife s academic educational preparation and National certification by the AMCB or its successor organizations, prescribe, dispense, order and administer medical devices, immunizing agents, laboratory tests and therapeutic, diagnostic and preventative measures. (6) A nurse-midwife who possesses a master s degree or its substantial equivalent, and National certification, and applies to the Board, is eligible to 18-6 (342662) No. 415 Jun. 09 Copyright 2009 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.6 receive a certificate from the Board which will authorize the nurse-midwife to prescribe, dispense, order, and administer drugs, including legend drugs and Schedule II through Schedule V controlled substances, as defined in The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. 780-101 780-144), in accordance with 18.6a (relating to prescribing and dispensing drugs) provided that the nurse-midwife demonstrates to the Board that: (i) The nurse-midwife has successfully completed at least 45 hours of course-work specific to advanced pharmacology at a level above that required by a professional nursing education program. (ii) The nurse-midwife has successfully completed 16 hours of advanced pharmacology within 2 years immediately preceding the application for prescriptive authority. (iii) The nurse-midwife is acting in accordance with the terms and conditions set forth in a collaborative agreement with a physician. (7) Perform medical services in the care of women and neonates that may go beyond the scope of midwifery, if the authority to perform those services is delegated by the collaborating physician in the collaborative agreement, and the delegation is consistent with standards of practice embraced by the nursemidwife and the relevant physician communities in this Commonwealth, as set forth in 18.401 18.402 (relating to medical doctor delegation of medical services). (8) Refer and transfer to the care of a physician, as provided for in the midwife practice guidelines or a collaborative agreement, or both, those women and neonates whose medical problems are outside the scope of midwifery practice and who require medical services which have not been delegated to the nurse-midwife in a collaborative agreement. (9) Review and revise the midwife practice guidelines as needed. (10) Carry out responsibilities placed by law or regulation upon a person performing the functions that are performed by a nurse-midwife. The provisions of this 18.6 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). The provisions of this 18.6 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 10, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial page (326815). (342663) No. 415 Jun. 09 18-7

49 18.6a DEPARTMENT OF STATE Pt. I 18.6a. Prescribing, dispensing and administering drugs. (a) No Schedule I controlled substances. A nurse-midwife may not prescribe or dispense Schedule I controlled substances as defined by section 4 of The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. 780-104). (b) Prescribing, dispensing and administering drugs. A nurse-midwife who has prescriptive authority may prescribe, administer and dispense drugs as follows: (1) A nurse-midwife may prescribe, dispense or administer Schedule II through V controlled substances and legend drugs in accordance with the following restrictions: (i) A nurse-midwife may not prescribe, dispense, order or administer a controlled substance except for a woman s acute pain. (ii) In the case of a Schedule II controlled substance, the dose must be limited to 72 hours and may not be extended except with the approval of the collaborating physician. (iii) In the case of a Schedule III or IV controlled substance, the prescription must be limited to 30 days and shall only be refilled with the approval of the collaborating physician. (iv) A nurse-midwife may prescribe, dispense, order or administer psychotropic drugs only after consulting with the collaborating physician. (v) A nurse-midwife may only prescribe or dispense a drug for a patient in accordance with the collaborative agreement. (vi) A nurse-midwife may not delegate prescriptive authority to another health care provider. (2) A nurse-midwife authorized to prescribe or dispense, or both, controlled substances, shall register with the United States Drug Enforcement Administration. (c) Prescription blanks. The requirements for prescription blanks are as follows: (1) Prescription blanks must bear the license number of the nurse-midwife and the name and contact information, including phone number, of the nursemidwife in a printed format at the heading of the blank, as well as the initials C.N.M. or similar designation. (2) The signature of the nurse-midwife must be followed by the initials C.N.M. or similar designation to identify the signer as a nurse-midwife. (3) A nurse-midwife may use a prescription blank generated by a hospital or other licensed healthcare facility, provided the information in paragraph (1) appears on the blank. (4) Prescription blanks may not be presigned by the nurse-midwife or collaborating physician. (d) Inappropriate prescribing. Any party who identifies an inappropriate prescription shall immediately advise the nurse-midwife or the collaborating physi- 18-8 (342664) No. 415 Jun. 09 Copyright 2009 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.7 cian. The nurse-midwife or collaborating physician shall advise the patient to modify or discontinue use of the drug as medically appropriate. In the case of a written prescription, the nurse-midwife or the collaborating physician shall notify the pharmacy of the changes to the prescription. The order to modify or discontinue the use of the drug or prescription must be noted in the patient s medical record. The nurse-midwife shall seek consultation as medically indicated. (e) Recordkeeping requirements. Recordkeeping requirements are as follows: (1) When prescribing a drug, the nurse-midwife shall record in the patient s medical record the name, amount, directions for use and doses of the drug prescribed, the number of refills, the date of the prescription and the nurse-midwife s name. When utilizing electronic prescribing, the nursemidwife shall comply with the requirements of the State Board of Pharmacy in 27.201 (relating to electronically transmitted prescriptions). (2) When dispensing a drug, the nurse-midwife shall record in the patient s medical record the name, amount, directions for use and doses of the medication dispensed, the date dispensed, and the nurse-midwife s name. (f) Compliance with regulations relating to prescribing, administering, dispensing, packaging and labeling of drugs. A nurse-midwife shall comply with 16.92 16.94 (relating to prescribing, administering and dispensing controlled substances; packaging; and labeling of dispensed drugs) and Department of Health regulations in 28 Pa. Code 25.51 25.58 (relating to prescriptions) and regulations regarding packaging and labeling dispensed drugs. See 16.94 and 28 Pa. Code 25.91 25.95 (relating to labeling of drugs, devices and cosmetics). The provisions of these sections 12 and 35 of the Medical Practice Act of 1985 (63 P. S. 422.12 and 422.35), unless otherwise noted. The provisions of this 18.6a adopted April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. 18.7. Disciplinary and corrective measures. (a) The Board may refuse, revoke, suspend, limit or attach conditions to the license of a nurse-midwife engaging in conduct prohibited by section 41(8) of the act (63 P. S. 422.41(8)) for Board-regulated practitioners. (b) The Board will order the emergency suspension of the license of a nursemidwife who presents an immediate and clear danger for the public health and safety, as required by section 40 of the act (63 P. S. 422.40). (c) The license of a nurse-midwife shall automatically be suspended, as required by section 40 of the act. (342665) No. 415 Jun. 09 18-8.1

49 18.8 DEPARTMENT OF STATE Pt. I The provisions of this 18.7 amended under section 2 of the act of April 4, 1929 (P. L. 160, No. 155) (63 P. S. 172); and sections 8, 12 and 35(a) of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.12 and 422.35(a)). The provisions of this 18.7 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. Immediately preceding text appears at serial page (326816). 18.8. [Reserved]. The provisions of this 18.8 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; reserved May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161. Immediately preceding text appears at serial page (114029). 18.9. Notification of changes in collaboration. (a) A nurse-midwife licensed to practice midwifery who is unable to maintain a collaborative agreement and cannot arrange interim coverage shall cease practicing until a collaborative agreement is in place. (b) A nurse-midwife shall notify the Board, in writing, of a change in or termination of a collaborative agreement or a change in mailing address within 30 days. The nurse-midwife shall provide the Board with the nurse-midwife s new address of residence, address of employment and any change of collaborating physician. A change in medical staff of a medical practice identified in the collaborative agreement is not a change in the collaborating agreement, so long as the named collaborating physician continues to collaborate with the nursemidwife under the collaborative agreement. (c) Failure of a nurse-midwife to notify the Board within 30 days of changes in, or a termination in the collaborating physician/nurse-midwife relationship is a basis for disciplinary action against the nurse-midwife s license. (d) A nurse-midwife with prescriptive authority who cannot continue to fulfill the requirements for prescriptive authority shall cease to prescribe and shall so notify the Board in writing within 30 days. The provisions of this 18.9 adopted under sections 12 and 35 of the Medical Practice Act of 1985 (63 P. S. 422.12 and 422.35). The provisions of this 18.9 adopted April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625. 18-8.2 (342666) No. 415 Jun. 09 Copyright 2009 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.11 Subchapter B. REGISTRATION AND PRACTICE OF ACUPUNCTURISTS AND PRACTITIONERS OF ORIENTAL MEDICINE Sec. 18.11. Definitions. 18.12. Licensure as an acupuncturist. 18.13. Requirements for licensure as an acupuncturist. 18.13a. Requirements for licensure as a practitioner of Oriental medicine. 18.14. Biennial registration requirements. 18.15. Practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a medical doctor. 18.15a. Scope of practice of acupuncturists and practioners of Oriental medicine. 18.16. [Reserved]. 18.17. [Reserved]. 18.18. Disciplinary and corrective measures. 18.19. [Reserved]. 18.11. Definitions. The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise: Acupuncture (i) The stimulation of certain points on or near the surface of the body by the insertion of needles to prevent or alleviate the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body. (ii) The term also includes the use of supplemental techniques. Acupuncture educational program Training and instruction in acupuncture or supplemental acupuncture techniques offered by a degree-granting institution authorized by the Department of Education that leads to a master s degree, master s level certificate or diploma or first professional degree, that meets the relevant and appropriate requirements of 22 Pa. Code (relating to education) and 24 Pa.C.S. Chapter 65 (relating to private colleges, universities and seminaries) and that meets or exceeds the standards required for acupuncture or Oriental medicine programs established by an accrediting agency recognized by the United States Department of Education. Acupuncture examination An examination offered or recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of acupuncture and herbal therapy to qualify for the privilege of practicing as an acupuncturist or as a practitioner of Oriental medicine. The Board recognizes the NCCAOM component examinations in acupuncture and sterilization procedures as the examination for registration as an acupuncturist and the NCCAOM examination component in Chinese herbology as the examination for registration as a practitioner of Oriental medicine. (347371) No. 424 Mar. 10 18-9

49 18.12 DEPARTMENT OF STATE Pt. I Acupuncture medical program An academic or clinical program of study in acupuncture which has been given category I continuing medical education credit by an institution accredited or recognized by the Accreditation Council on Continuing Medical Education to conduct category I continuing medical education courses. Acupuncturist An individual licensed to practice accupuncture by the Board. Chinese herbology The study of the use of herbs in the Oriental medicine tradition. Herbal therapy The application of Chinese herbology to the treatment of acupuncture patients. NCCAOM The National Certification Commission for Acupuncture and Oriental Medicine. Practitioner of Oriental medicine An acupuncturist who is licensed by the Board to use herbal therapy. Supplemental techniques The use of traditional and modern Oriental therapeutics, heat therapy, moxibustion, electrical and low level laser stimulation, acupressure and other forms of massage, and counseling that includes the therapeutic use of foods and supplements and lifestyle modifications. The provisions of this 18.11 amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803); and section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8). The provisions of this 18.11 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644; amended January 8, 2010, effective Janaury 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial pages (342667) to (342668). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18.12. Licensure as an acupuncturist. A medical doctor who intends to practice acupuncture and any other individual who intends to practice acupuncture shall obtain a license from the Board as an acupuncturist. The provisions of this 18.12 amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803); and section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8). 18-10 (347372) No. 424 Mar. 10 Copyright 2010 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.13 The provisions of this 18.12 amended April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644; amended January 8, 2010, effective January 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial page (342668). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18.13. Requirements for licensure as an acupuncturist. (a) The Board will license as an acupuncturist a person who satisfies the following requirements: (1) Has successfully completed an acupuncture educational program which includes a course in needle sterilization techniques. (2) Has obtained a passing grade on an acupuncture examination or has been certified by NCCAOM. If the examination was not taken in English, but is otherwise acceptable and a passing score was secured, the Board will accept the examination result if the applicant has also secured a score of 550 on the test of English as a Foreign Language (TOEFL). (b) The Board will license as an acupuncturist a medical doctor who satisfies the following requirements: (1) Has successfully completed 200 hours of training in acupuncture medical programs including examinations required by those programs. (2) Submits an application to register as an acupuncturist accompanied by the required fee. For the fee amount, see 16.13 (relating to licensure, certification, examination and registration fees). (c) Prior to January 1, 1988, the Board will register as an acupuncturist a medical doctor who satisfies the requirements of subsection (a), (b) or the following: (1) Has at least 3 years of acupuncture practice a minimum of 500 patient visits per year documented to the satisfaction of the Board. (2) Submits an application to register as an acupuncturist accompanied by the required fee. For the fee amount, see 16.13. The provisions of this 18.13 amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803); and section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8). The provisions of this 18.13 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644; amended January 8, 2010, effective January 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial pages (342669) and (326819). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct); and 49 Pa. Code 18.13a (relating to requirements for licensure as a practitioner of Oriental medicine). (347373) No. 424 Mar. 10 18-11

49 18.13a DEPARTMENT OF STATE Pt. I 18.13a. Requirements for licensure as a practitioner of Oriental medicine. (a) An acupuncturist who also intends to use herbal therapy is required to be licensed by the Board as a practitioner of Oriental medicine. (b) The Board will license an acupuncturist as a practitioner of Oriental medicine if the licensee, in addition to meeting the requirements under 18.13 (relating to requirements for licensure as an acupuncturist) has fulfilled one of the following: (1) Successfully completed an acupuncture education program that includes the study of Chinese herbology and has passed the NCCAOM examination component on Chinese herbology. (2) Has obtained NCCAOM certification in Chinese herbology or Oriental medicine, which includes passing the NCCAOM examination component in Chinese herbology. (c) An acupuncturist registered with the Board prior to April 14, 2007, may obtain a license as a practitioner or Oriental medicine if the acupuncturist can demonstrate one of the following: (1) Successful completion of a Chinese herbology or Oriental medicine education program recognized by the licensing authority of another state or United States territory for the practice of herbal therapy or Oriental medicine and successful completion of an examination in Chinese herbology or Oriental medicine recognized by the licensing authority of another state or United States territory for the practice of herbal therapy or Oriental medicine. (2) NCCAOM certification in Chinese herbology or Oriental medicine. (3) The achievement of cumulative qualifications that the Board determines to be equivalent to the standard requirements for registration as a practitioner of Oriental medicine. (d) This subsection does not apply to a medical doctor licensed as an acupuncturist nor does it restrict the practice of medicine by a medical doctor. The provisions of this 18.13a amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803); and section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8). The provisions of this 18.13a adopted April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644; amended January 8, 2010, effective January 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial pages (326819) to (326820). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18-12 (347374) No. 424 Mar. 10 Copyright 2010 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.14 18.14. Biennial registration requirements. (a) Acupuncturists and practitioners of Oriental medicine shall register biennially and submit the appropriate registration fee to engage in the practice of acupuncture for the biennial period. (b) Procedures for biennial registration of acupuncturists and practitioners of Oriental medicine are outlined in 16.15 (relating to biennial registration; inactive status and unregistered status). (c) The biennial registration fee is set forth in 16.13 (relating to licensure, certification, examination and registration fees). The provisions of this 18.14 amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803). The provisions of this 18.14 amended April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644. Immediately preceding text appears at serial page (222907). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18.15. Practice responsibilities of acupuncturist and practitioner of Oriental medicine who is not a medical doctor. (a) Responsibilities to patient. In relation to the acupuncture patient, the acupuncturist and the practitioner of Oriental medicine: (1) Shall perform an acupuncture or Oriental medicine evaluation and develop an acupuncture or Oriental medicine treatment plan. (2) May treat the patient s symptoms without the condition being diagnosed by a physician, dentist or podiatrist for 60 calendar days from the date of the first treatment. (3) May treat the patient s symptoms beyond 60 calendar days from the date of first treatment if the patient has obtained an examination and diagnosis from a physician, dentist or podiatrist. (4) Shall promptly refer the patient to a physician, dentist or podiatrist, as appropriate to the patient s condition, if the acupuncturist or practitioner of Oriental medicine determines that further acupuncture or Oriental medicine treatment is contraindicated for the patient or determines that the patient s symptoms have worsened. (5) Shall consult with the patient s physician, dentist, podiatrist or other health care practitioner upon request of the patient. (6) Shall cooperate with the patient s physician, dentist or podiatrist in regard to the coordination of the patient s care, and comply with restrictions or conditions as directed by the physician, dentist or podiatrist. (347375) No. 424 Mar. 10 18-12.1

49 18.15a DEPARTMENT OF STATE Pt. I (7) May not diagnose a physical or mental ailment or condition or prescribe or dispense a drug. This provision does not prohibit the use of diagnostic billing codes for billing or reimbursement purposes. (8) Shall comply strictly with sterilization standards relative to aseptic practices. (9) Shall maintain patient records in a manner consistent with 16.95 (relating to medical records). (b) Identification of acupuncturist or practitioner of Oriental medicine. An acupuncturist who is not a medical doctor shall wear a tag or badge with lettering clearly visible to the patient bearing the acupuncturist s name and the title acupuncturist or practitioner of Oriental medicine, as appropriate. The use of the word doctor on this tag or badge is prohibited. The provisions of this 18.15 amended January 8, 2010, effective January 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial pages (326820) to (326821). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18.15a. Scope of practice of acupuncturists and practitioners of Oriental medicine. (a) An acupuncturist may practice acupuncture and use supplemental techniques but may not use herbal therapy. (b) A practitioner of Oriental medicine may practice acupuncture and use supplemental techniques including herbal therapy. A practitioner of Oriental medicine is not prohibited from dispensing or administering therapeutic herbs that contain ingredients that are similar or equivalent to active ingredients in drugs as classified by the Federal Food and Drug Administration. (c) This subsection does not limit the scope of practice of a medical doctor who is registered as an acupuncturist. The provisions of this 18.15a amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803); and section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8). The provisions of this 18.15a adopted April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644; amended January 8, 2010, effective January 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial page (326821). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18-12.2 (347376) No. 424 Mar. 10 Copyright 2010 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.16 18.16. [Reserved]. The provisions of this 18.16 reserved April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644. Immediately preceding text appears at serial pages (222908) to (222909). 18.17. [Reserved]. The provisions of this 18.17 reserved April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644. Immediately preceding text appears at serial pages (222909) to (222910). 18.18. Disciplinary and corrective measures. (a) The Board may refuse, revoke, suspend, limit or attach conditions to the license of an acupuncturist or practitioner of Oriental medicine for engaging in conduct prohibited under section 41 of the act (63 P. S. 422.41) for Boardregulated practitioners. (b) The Board will order the emergency suspension of the license of an acupuncturist or practitioner of Oriental medicine who presents an immediate and clear danger to the public health and safety, as required under section 40 of the act (63 P. S. 422.40). (c) The license of an acupuncturist or practitioner of Oriental medicine shall automatically be suspended, as required under section 40 of the act. The provisions of this 18.18 amended under section 3 of the Acupuncture Licensure Act (63 P. S. 1803); and section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8). The provisions of this 18.18 adopted January 2, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 24; amended May 19, 1989, effective May 20, 1989, 19 Pa.B. 2161; amended April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644; amended January 8, 2010, effective January 9, 2010, 40 Pa.B. 250. Immediately preceding text appears at serial page (326822). This section cited in 49 Pa. Code 5.81 (relating to unprofessional and immoral conduct). 18.19. [Reserved]. The provisions of this 18.19 corrected January 9, 1987, effective immediately and applies retroactively to December 31, 1986, 17 Pa.B. 185; reserved April 13, 2007, effective April 14, 2007, 37 Pa.B. 1644. Immediately preceding text appears at serial page (222910). (347377) No. 424 Mar. 10 18-12.3

18-12.4 (347378) No. 424 Mar. 10 Copyright 2010 Commonwealth of Pennsylvania

Subchapter C. [Reserved] Sec. 18.21. [Reserved]. 18.22. [Reserved]. 18.31. [Reserved]. 18.41. [Reserved]. 18.42. [Reserved]. 18.51. [Reserved]. 18.52. [Reserved]. 18.53. [Reserved]. 18.54. [Reserved]. 18.55. [Reserved]. 18.56. [Reserved]. 18.57. [Reserved]. 18.61. [Reserved]. 18.62. [Reserved]. 18.63. [Reserved]. 18.64. [Reserved]. 18.71. [Reserved]. 18.81. [Reserved]. 18.91. [Reserved]. 18.101. [Reserved]. 18.111. [Reserved]. The provisions of this Subchapter C reserved under section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8); and sections 2.1(k) and (l) and 8.1 8.3 of The Professional Nursing Law (63 P. S 212.1(k) and (l) and 218.1 218.3), unless otherwise noted. The provisions of this Subchapter C reserved April 19, 2013, effective April 20, 2013, 43 Pa.B. 2145, unless otherwise noted. Immediately preceding text appears at serial pages (348882), (271689) to (271692), (272603) to (272604), (271695) to (271696) and (323415) to (323416). This subchapter cited in 28 Pa. Code 9.678 (relating to PCPs); 55 Pa. Code 1153.41a (relating to medication prescription statement of policy); 55 Pa. Code 2380.122a (relating to labeling of medications statement of policy); 55 Pa. Code 2380.124a (relating to medication log statement of policy); 55 Pa. Code 2380.126a (relating to adverse reaction statement of policy); 55 Pa. Code 5200.42a (relating to medication prescription statement of policy); 55 Pa. Code 5210.58a (relating to medication prescription statement of policy); 55 Pa. Code 6400.162a (relating to labeling of medication statement of policy); 55 Pa. Code 6400.163a (relating to use of prescription medication statement of policy); 55 Pa. Code 6400.164a (relating to medication log statement of policy); 55 Pa. Code 6400.166a (relating to adverse reaction statement of policy); 55 Pa. Code 6500.132a (relating to labeling of medication statement of policy); 55 Pa. Code 6500.133a (relating to use of prescription medications statement of policy); 55 Pa. Code 6500.134a (relating to medication log statement of policy); and 55 Pa. Code 6500.136a (relating to adverse reaction statement of policy). (387689) No. 515 Oct. 17 18-13

49 18.21 18.21. [Reserved]. 18.22. [Reserved]. 18.31. [Reserved]. 18.41. [Reserved]. 18.42. [Reserved]. 18.51. [Reserved]. 18.52. [Reserved]. 18.53. [Reserved]. The provisions of this 18.53 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. 422.15(b)); and section 2(1) of the Professional Nursing Law (63 P. S. 212(1)); reserved under section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8); and sections 2.1(k) and (l) and 8.1 8.3 of The Professional Nursing Law (63 P. S. 212.1(k) and (l) and 218.1 218.3). The provisions of this 18.53 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; reserved April 19, 2013, effective April 20, 2013, 43 Pa.B. 2145. Immediately preceding text appears at serial pages (271690) to (271691). 18.54. [Reserved]. The provisions of this 18.54 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. 422.15(b)); and section 2(1) of the Professional Nursing Law (63 P. S. 212(1)); reserved under section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8); and sections 2.1(k) and (l) and 8.1 8.3 of The Professional Nursing Law (63 P. S. 212.1(k) and (l) and 218.1 218.3). The provisions of this 18.54 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; reserved April 19, 2013, effective April 20, 2013, 43 Pa.B. 2145. Immediately preceding text appears at serial pages (271691) to (271692) and (272603). 18-14 (387690) No. 515 Oct. 17 Copyright 2017 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.55 18.55. [Reserved]. The provisions of this 18.55 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. 422.15(b)); and section 2(1) of the Professional Nursing Law (63 P. S. 212(1)); reserved under section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8); and sections 2.1(k) and (l) and 8.1 8.3 of The Professional Nursing Law (63 P. S. 212.1(k) and (l) and 218.1 218.3). The provisions of this 18.55 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; corrected December 29, 2000, effective November 18, 2000, 30 Pa.B. 6911; reserved April 19, 2013, effective April 20, 2013, 43 Pa.B. 2145. Immediately preceding text appears at serial pages (272603) to (272604). 18.56. [Reserved]. The provisions of this 18.56 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. 422.15(b)); and section 2(1) of the Professional Nursing Law (63 P. S. 212(1)); reserved under section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8); and sections 2.1(k) and (l) and 8.1 8.3 of The Professional Nursing Law (63 P. S. 212.1(k) and (l) and 218.1 218.3). The provisions of this 18.56 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; reserved April 19, 2013, effective April 20, 2013, 43 Pa.B. 2145. Immediately preceding text appears at serial page (272604). 18.57. [Reserved]. The provisions of this 18.57 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. 422.15(b)); and section 2(1) of the Professional Nursing Law (63 P. S. 212(1)); reserved under section 8 of the Medical Practice Act of 1985 (63 P. S. 422.8); and sections 2.1(k) and (l) and 8.1 8.3 of The Professional Nursing Law (63 P. S. 212.1(k) and (l) and 218.1 218.3). The provisions of this 18.57 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; reserved April 19, 2013, effective April 20, 2013, 43 Pa.B. 2145. Immediately preceding text appears at serial pages (272604) and (271695). (370205) No. 473 Apr. 14 18-15

49 18.61 DEPARTMENT OF STATE Pt. I 18.61 18.64. [Reserved]. 18.71. [Reserved]. 18.81. [Reserved]. 18.91. [Reserved]. 18.101. [Reserved]. 18.111. [Reserved]. Subchapter D. PHYSICIAN ASSISTANTS Sec. 18.121. Purpose. 18.122. Definitions. GENERAL PROVISIONS PHYSICIAN ASSISTANT EDUCATIONAL PROGRAMS 18.131. Recognized educational programs/standards. 18.132. [Reserved]. LICENSURE OF PHYSICIAN ASSISTANTS AND REGISTRATION OF SUPERVISING PHYSICIANS 18.141. Criteria for certification as a physician assistant. 18.142. Written agreements. 18.143. Criteria for registration as a supervising physician. 18.144. Responsibility of primary supervising physician. 18.145. Biennial registration requirements; renewal of physician assistant license. 18.146. Professional liability insurance coverage for licensed physician assistants. PHYSICIAN ASSISTANT UTILIZATION 18.151. Role of physician assistant. 18.152. Prohibitions. 18.153. Executing and relaying medical regimens. 18.154. Substitute supervising physician. 18-16 (370206) No. 473 Apr. 14 Copyright 2014 Commonwealth of Pennsylvania

Ch. 18 OTHER PRACTITIONERS 49 18.121 18.155. Satellite locations. 18.156. Monitoring and review of physician assistant utilization. 18.157. Administration of controlled substances and whole blood and blood components. 18.158. Prescribing and dispensing drugs, pharmaceutical aids and devices. 18.159. Medical records. MEDICAL CARE FACILITIES AND EMERGENCY MEDICAL SERVICES 18.161. Physician assistant employed by medical care facilities. 18.162. Emergency medical services. 18.163. [Reserved]. 18.164. [Reserved]. IDENTIFICATION AND NOTICE RESPONSIBILITIES 18.171. Physician assistant identification. 18.172. Notification of changes in employment. DISCIPLINE 18.181. Disciplinary and corrective measures. 18.182. [Reserved]. 18.183. [Reserved]. This subchapter cited in 28 Pa. Code 107.12a (relating to specified professional personnel statement of policy). GENERAL PROVISIONS 18.121. Purpose. This subchapter implements section 13 of the act (63 P. S. 422.13) pertaining to physician assistants and provides for the delegation of certain medical tasks to qualified physician assistants by supervising physicians when the delegation is consistent with the written agreement. The provisions of this 18.121 amended under sections 8, 13 and 36 of the Medical Practice Act of 1985 (63 P. S. 422.8, 422.13 and 422.36). The provisions of this 18.121 amended August 13, 1993, effective August 14, 1993, 23 Pa.B. 3780; amended November 17, 2006, effective November 18, 2006, 36 Pa.B. 7009. Immediately preceding text appears at serial pages (299569) to (299570). (370207) No. 473 Apr. 14 18-17